Magnitude and associated factors of medication administration error among nurses working in Amhara Region Referral Hospitals, Northwest Ethiopia

Number of Readmissions and Its Determinants Among Patients With Heart Failure at Referral Hospitals in Amhara Region, Northwest Ethiopia: A Cross-Sectional Study Using Zero-Inflated Negative Binomial Model, 2023

Background

Heart failure is a leading cause of hospital readmissions in the Amhara region, Northwest Ethiopia.

Aim

This study aimed to determine the number of readmissions and identify the determinants among patients with heart failure at referral hospitals in the Amhara region, Northwest Ethiopia, in 2023.

Methods

A cross-sectional study was conducted with 663 heart failure patients in Amhara region referral hospitals from September 2022 to February 2023. Simple random sampling was used for patient selection, and data were collected through chart reviews and interviewer-administered questionnaires. Zero-inflated negative binomial models were applied for data analysis. Data collection tools were pre-tested for reliability and validity.

Results

Among 663 patients, 237 (35.7%) were readmitted at least once. An increased respiratory rate (IRR = 1.015; 95% CI: 1.0004, 1.031; p < 0.044) and longer medication duration (IRR = 1.011; 95% CI: 1.016, 1.051; p < 0.0001) were associated with more readmissions. Patients with poor social support had 59.4% fewer readmissions compared to those with good social support (IRR = -1.595; 95% CI: -0.02, -0.005; p < 0.041). A higher body mass index (IRR = 0.115; 95% CI: 0.035, 0.196; p < 0.004) was linked with a higher likelihood of remaining in the "always-zero" group, while an increased pulse rate reduced the odds (IRR = -0.013; 95% CI: -0.025, -0.008; p < 0.036). The mortality rate among readmitted patients was 11.39%.

Conclusion

This study found significant readmission rates among HF patients. Factors such as respiratory rate and medication duration were linked to increased readmissions, while poor social support was associated with fewer readmissions, this likely reflects limited healthcare access in low- and middle-income countries among individuals with lower social support. The high mortality rate underscores the need for targeted interventions to improve patient outcomes.

Errors Associated With Medication Administration by a Nurse During Hospitalisation: A Prospective Observational Multicentric Study

AIMS

To explore all medication administration errors (MAEs) throughout the entire process of medication administration by nurses in the inpatient setting, to describe their prevalence, and to analyse associated factors, including deviation from the good practice standards.

BACKGROUND

Worldwide, MAEs are very common and regarded as a serious risk factor to inpatient safety. Nurses assume an essential role in the hospital setting during the administration of medications.

DESIGN

The prospective observational study was carried out in accordance with the STROBE guidance.

METHODS

This study was conducted in four regional hospitals from June to August 2021. MAEs were collected when nurses administered medications to the adult inpatients during the morning, noon, and evening medication rounds at the internal, surgical, and follow-up care departments in each hospital over three consecutive days. Direct observation by the multidisciplinary team was employed. MAEs were classified as major MAEs (from the potentially most serious and common to all drug forms), specific MAEs (specific to a drug form), and procedural MAEs (e.g., patient identification, hygiene standards, or generic drug substitution). Predictors of either major MAE or specific MAE frequency were analysed using the generalised linear model and the decision tree model.

RESULTS

Overall, 58 nurses administering medication to 331 inpatients at 12 departments were observed. In total, 6356 medication administrations were observed, of which 461 comprised major MAEs, 1497 specific MAEs, and 12,045 procedural MAEs. The predictors of the occurrence of major MAEs and specific MAEs were the specific hospital, the nurse's length of practice (less than 2 years), and two procedural MAEs (the unclear prescription and the wrong strength).

CONCLUSIONS

Non-adherence to the standard processes in healthcare facilities for prescribing and administering drugs increased the prevalence of severe MAEs. Determinants of MAE occurrence such as incorrect prescriptions or limited experience of nurses should be considered.

IMPLICATION FOR THE PROFESSION AND PATIENT CARE

The identified determinants of MAE should be considered by hospital stakeholders in their support programs to reduce the level of burden for nurses during medication administration.

PATIENT OR PUBLIC CONTRIBUTION

Neither patients nor public was not involved in the design, data collection, or dissemination plans of this study. The researchers observed nurse care delivery at medical departments acting as passive participants.

Investigating pediatric nurses' perceptions of factors contributing to MAEs at Yendi hospital, Ghana

BACKGROUND

Medication administration errors (MAEs) are a critical concern in pediatric healthcare, contributing to adverse drug events (ADEs) and negatively impacting patient health.

OBJECTIVES

This study explores pediatric nurses' perceptions of factors contributing to MAEs at Yendi Municipal Hospital to develop interventions enhancing patient safety.

METHODS

A descriptive cross-sectional survey was conducted among 143 nurses at Yendi Municipal Hospital using structured questionnaires. Data were analysed using SPSS 26.0 and Excel 2016. Bivariate analysis examined relationships between socio-demographic characteristics and MAEs.

RESULTS

Contributing factors to MAEs included inadequate training (91.6%), misunderstanding medical abbreviations (88.8%), poor supervision (92.3%), eagerness to sign out shifts (70.6%), improper handover (88.8%), inadequate staff (77.6%), dosage miscalculations (83.9%), and illegible handwriting (81.8%). Significant associations were found between MAEs and the type of unit/ward (X²=6.25, p = 0.012) and educational level (Fisher Exact test = 4.20, p = 0.036).

CONCLUSION

Inadequate training, poor supervision, and communication issues are major contributors to MAEs in pediatric settings. Targeted interventions can significantly improve patient safety and care quality.

Recognition and evaluation of mental workload in different stages of perceptual and cognitive information processing using a multimodal approach

This study explores the effects of different perceptual and cognitive information processing stages on mental workload by assessing multimodal indicators of mental workload such as the NASA-TLX, task performance, ERPs and eye movements. Repeated measures ANOVA of the data showed that among ERP indicators, P1, N1 and N2 amplitudes were sensitive to perceptual load (P-load), P3 amplitude was sensitive to P-load only in the prefrontal region during high cognitive load (C-load) states, and P3 amplitude in the occipital and parietal regions was sensitive to C-load. Among the eye movement indicators, blink frequency was sensitive to P-load in all C-load states, but to C-load in only low P-load states; pupil diameter and blink duration were sensitive to both P-load and C-load. Based on the above indicators, the k-nearest neighbours (KNN) algorithm was used to propose a classification method for the four different mental workload states with an accuracy of 97.89%.Practitioner summary: Based on the results of this study, it is possible to implement the monitoring of mental workload states and optimise brain task allocation in operations involving high mental workload, such as human-computer interaction.

Clinical Practice Competence and Its Associated Factors Among Generic Nursing Students Learning at Public Universities: A Cross-Sectional Study

Introduction

One of the global strategic direction and policy priorities in 2021 through 2025 is preservice education of nurses. Even though, quality education is the foundation to produce competent health workers, ensuring the competence of the health professionals is as imperative as maximizing their number. This study aims to fill the literature gap among nursing students in public universities.

Objectives

The purpose of this study is to assess the prevalence of clinical practice competence and its associated factors among graduating BSc nursing students in public universities from July 15 to August 15, 2022.

Methods

An institutional-based cross-sectional study was carried out in randomly selected public universities in eastern Ethiopia. A total of 143 students were systematically selected to fill out the questionnaire through multistage sampling. Frequency, mean, and standard deviations of independent variables and proportion of clinical practice competence were analyzed using descriptive statistics. AOR with a p-value of <.05 was used to declare a significant association.

Results

The study found that 69 (53.1%) of study participants were clinically competent. Students with good clinical instructors [AOR: 3.79, 95%CI: 1.56-9.21], learning in a conducive clinical setting [AOR: 3.59, 95%CI: 1.26-10.23] and assessed using measurable methods [AOR: 3.77, 95%CI: 1.53-9.30] were significantly associated.

Conclusion

In this study, almost one in two of the students was clinically incompetent. Respective stakeholders could enhance students' competence by monitoring and evaluating students during clinical practice, creating favorable learning settings, and developing comprehensive assessment methods.

A cross-sectional study of the knowledge, skills, and 6 rights on medication administration by nurses at emergency department

Introduction: Medication errors occur when a patient is given the wrong drug or receives incorrect pharmacological therapy. Incorrect drug administration can cause fatal errors resulting in the patient’s death. Approximately 44,000-98,000 patients die each year due to medication errors and this condition is found often in the Emergency Room (ER) due to the complexity. Therefore, this study aims to analyze the relationship between nurses’ knowledge, skills, and 6 rights on medication at Emergency Department. Design and Methods: This is an analytical observational study involving 70 nurses randomly selected using consecutive sampling and working at the ER department of Saiful Anwar Hospital Malang. Data were collected through a questionnaire and analyzed descriptively to determine the knowledge and skills of nurses and the implementation of the correct principles of medication administration. Results: The results showed that most of the emergency room nurses had good knowledge and skills in applying the correct principles of medicine. However, the majority could not calculate the drug dose accurately. The spearman rank results showed that there was a relationship between knowledge and the 6 correct drug principles (p<0.001, α= 0,05; r = 0.491) with a percentage of 44%. This indicates that a higher knowledge results in the correct implementation of the drug. Similarly, there was a significant positive correlation between skills and proper medicine (p<0.001, α= 0,05; r = 0.378). Conclusions: It can be inferred that a higher nurse’s knowledge and skill results in a better administration of medicine.

Magnitude and Predictors of Medication Administration Errors Among Nurses in Public Hospitals in Northeastern Ethiopia

Introduction

Currently, patient safety and quality of care have become a public health concern. However, medication administration errors are common in global medical settings and may cause problems ranging from the subtle to the fatal.

Objective

To assess the Magnitude and determinant factors of Medication Administration Errors among nurses working in the public hospitals in the Eastern Amhara region, Northeastern Ethiopia, 2022.

Methods

A multicenter hospital-based cross-sectional study design was used in South Wollo Zone public hospitals from February-March 2022, with 423 nurses selected using a simple random method. Data were collected using a pretested questionnaire, entered, and analyzed using EpiData 4.6.0 and SPSS 26. Predictors of medication administration errors were identified by multivariate logistic regression.

Result

Magnitude of Medication Administration Errors in the study areas was 229 (55%), 95% CI [0.501, 0.599]. Service provision to ≥ 11 patients per day (AOR: 2.52, 95% CI [1.187, 6.78]), interruption (AOR: 4.943, 95% CI [2.088, 11.712]), lack of training (AOR: 6.35, 95% CI [3.340, 7.053]), ≥ 4 years and 5-9 years of experience respectively (AOR: 3.802, 95% CI [1.343, 10.763]), (AOR: 2.804, 95% CI [1.062, 7.424]) were factors associated with Medication Error. likewise, shortage of time (AOR: 5.637, 95% CI [2.575, 12.337]), lack of guidelines (AOR: 2.418, 95% CI [1.556, 5.086]), workload (AOR: 7.32, 95% CI [3.146, 17.032]) and stress (AOR: 12.061, 95% CI [33.624, 53.737]) were determinant factors for Medication Administration Errors.

Conclusion and recommendation

In the current study, medication administration errors were common. Patient load, interruption, nurse's service experience, time deficit, stress, a lack of training, and the absence of guidelines were associated with medication administration errors. Therefore, ongoing training, the availability of guidelines, the presence of a good working environment, and the retention of experienced nurses can all be critical steps in improving patient safety.

Factors to predict the knowledge, attitude and practice of nursing interruptions among nurses: A nationwide cross-sectional survey

AIM

To identify the knowledge, attitude and practice of nursing interruptions and related factors among nurses in China.

BACKGROUND

Nursing interruptions are extremely common and have introduced major security risks and harm to hospitalized patients. However, nursing interruptions' factors are not well known.

DESIGN

A nationwide cross-sectional descriptive survey.

METHODS

A multistratified random sampling method was used to obtain nurses from five provinces in China. We collected data by online questionnaires (the Knowledge, Attitude and Practice Questionnaire of Nursing Interruptions, the Chinese Revised Safety Attitude Questionnaire and the Coping Adaptation Processing Scale). We used the Mann-Whitney test, the Kruskal-Wallis test, Spearman's linear correlation analysis and multiple linear stepwise regression to analyze the data. A STROBE checklist was used to report the results.

RESULTS

Of the 14500 questionnaires distributed, 14302 (98.6 %) were returned. The mean score was 79.69 (SD 17.73) and the level was medium. Having attended nursing interruptions training and attended nursing safety training, safety attitude, coping ability and position were positive factors, while age and marital status were negative factors (F=1068.226, p < 0.001, R² =0.374, adjusted R² =0.373).

CONCLUSIONS

Chinese nurses expressed a moderate level of knowledge, attitude and practice of nursing interruptions. Safety attitude, having attended nursing interruptions training, coping ability, having attended nursing safety training, position, age and marital status were predictors.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers should pay attention to the influencing factors of clinical nurses' knowledge, attitude and practice of nursing interruptions and take effective individualized training for clinical nurses with different ages, positions and marital status to improve their coping ability, so as to ensure nursing safety and improve nursing quality.

Adherence to Covid-19 mitigation measures and its associated factors among health care workers at referral hospitals in Amhara regional state of Ethiopia

Introduction

With fragile health care systems, sub-Saharan Africa countries like Ethiopia are facing a complex epidemic, and become difficult to control the noble coronavirus. The use of COVID-19 preventive measures is strongly recommended. This study aimed to assess the adherence of COVID-19 mitigation measures and associated factors among health care workers.

Methods

A facility-based cross-sectional study was conducted among health care workers at referral hospitals in the Amhara regional state of Ethiopia from May 15 to June 10; 2021. It was a web-based study using an online questionnaire. STATA 14.2 was used for data analysis. Variables with a p-value<0.05 at 95% confidence level in multivariable analysis were declared as statistically significant using binary logistic regression.

Result

Adherence to COVID-19 mitigation measures was 50.24% in the current study. The odd of adherence of participants with a monthly income of ≥12801birr was 15% whereas the odds of adherence of participants who hesitate to take the COVID 19 vaccine were 10% as compared to those who don’t hesitate. Participants who had undergone COVID-19 tests adhered 6.64 times more than their counterparts. Those who believe adequate measurements are taken by the government adhered 4.6 times more than those who believe not adequate. Participants who believe as no risk of severe disease adhered 16% compared to those with fear of severe disease. Presence of households aged >60years adhered about 7.9 times more than with no households aged>60. Participants suspected of COVID-19 diagnosis adhered 5.7 times more than those not suspected.

Conclusion

In this study, a significant proportion of healthcare workers did not adhere to COVID-19 mitigation measures. Hence, giving special attention to healthcare workers with a monthly income of ≥12801 birr, being hesitant towards COVID-19 vaccine, being aged 26–30, and perceiving no risk of developing a severe infection is crucial to reduce non-adherence.

Nursing Students' Knowledge, Personality Traits, and Self-Efficacy Related to Medication Administration Error

BACKGROUND

Nursing education influences medication administration practices, which involve clinical decision making and risk perceptions.

METHOD

This mixed-methods concurrent nested study explored the relationship among knowledge, personality traits, and self-efficacy related to medication administration error in fourth-year, prelicen-sure nursing students (n = 60) who were recruited from three campuses of a large university.

RESULTS

Results indicated low mean knowledge (70.75) and neuroticism (2.44) scores, and high mean self-efficacy and confidence (5.78) and conscientiousness (4.51) scores. Conscientiousness was correlated with both knowledge (r = .271, p = .036) and neuroticism (r = -.313, p = .015). Thematic analysis yielded four themes: nature of risk perceptions, more opportunities to learn, experiences with medication administration error, and intrinsic characteristics influence errors. Convergence was evident in both knowledge and personality data; self-efficacy/confidence and risk perceptions data diverged.

CONCLUSION

Knowledge, personality traits, and self-efficacy appear to influence nursing students' risk perceptions of medication administration error, indicating an area for future research. [J Nurs Educ. 2022;61(7):367-374.].

Nursing errors in intensive care unit and their association with burnout, anxiety, insomnia and working environment: a cross-sectional study

BACKGROUND

In intensive care units (ICU), commonly identified nursing errors may have a negative impact on short- and long-term patient outcomes. Current data is scarce regarding nurses' burnout, insomnia, and anxiety impact on medication and several other types of nursing errors. This study aimed to record the commonness of various nursing errors, including checking patient data, medication preparation and administration, and infection control measures. It also aimed to investigate if "nurse-related" or "ICU-related" features may be associated with nursing error occurrence.

MATERIAL-METHODS

A sample of nurses employed in four Greek ICUs was evaluated using the self-completed Athens Insomnia Scale, the State-Trait Anxiety Inventory Form Y, and the Maslach Burnout Inventory. Moreover, we also recorded the sociodemographic characteristics of the ICU nurses, data regarding nursing errors and common practices, and variables regarding the working environment. We conducted a multinominal regression analysis to identify the variables independently associated with each error/mistake.

RESULTS

Ninety ICU nurses from the 99 addressed returned the completed questionnaires. The most frequent mistakes referred to drug preparation and administration, with 43.3 % of nurses reporting being "always/very often" distracted when preparing a drug and 90 % that "half of the times" they administer medication at unscheduled hours, followed in frequency by errors regarding the proper use of antiseptic solutions. Medication errors were independently predicted by state anxiety, satisfaction regarding training, emotional exhaustion score, number of ICU beds, and weekdays off work per month. In contrast, errors regarding infection control were independently associated with weekdays off work per month.

CONCLUSION

Medication errors are the commonest type of nursing error. Although several risk factors have been identified, no universal "nurse-related" or "ICU-related" factor can predict all types of errors. HIPPOKRATIA 2022, 26 (3):110-117.

Nursing students' risk perceptions related to medication administration error: A qualitative study

AIM

The purpose of this study was to explore and describe pre-licensure nursing students' perceptions of risk for medication administration errors in fourth-year baccalaureate student nurses from three campuses at a large central Pennsylvania university.

BACKGROUND

Medication administration errors continue to be a significant safety concern in healthcare settings. Pre-licensure nursing education is a critical time period during which to have an impact on future medication administration practices. Perception of risk influences decision making and behavior, including nursing clinical decision making.

DESIGN

This descriptive, exploratory study involved a qualitative design.

METHODS

A thematic analysis of the qualitative data resulting from 60 individual, in-depth semi-structured interviews was conducted.

RESULTS

The participants offered rich, detailed narratives which revealed the following themes: (1) the nature of risk perceptions, (2) more opportunities to learn, (3) experiences with medication administration error, and (4) intrinsic characteristics influence errors.

CONCLUSIONS

The findings provide a broad description of the nature of student nurse risk perceptions for future medication administration errors. Recommendations for nursing education practice and pedagogy include additional clinical experiences, modified pharmacology curricula and instruction, and expanded simulations involving medication administration error.

Evaluation of medication errors in the hospital environment

INTRODUCTION

Healthcare is inherently associated with a risk to patient health. One risk is associated with medication-related errors, which are commonly reported adverse events. By analyzing the root causes of medication errors, effective preventive measures can be proposed to reduce their likelihood. This study aimed to identify the reasons of medication administration errors, determine the number of medication administration errors reported, and describe the barriers hindering reporting.

METHODOLOGY

The study used a standardized Questionnaire Medication Administration Error Survey (MAE survey) that was quantitatively analyzed. The study involved 112 nurses from four hospitals in the South Bohemian Region.

RESULTS

Risk factors that increase the likelihood of medication administration errors include similarity of drug names (3.7 ± 1.3) and packaging (3.9 ± 1.5), frequent prescription changes for patients (3.2 ± 1.5), illegibility of written prescriptions (3.1 ± 1.6), a lack of clarity of medical records (2.6 ± 1.5). Only a proportion of medication administration errors are reported by nurses (16% to 21%). The reluctance of nurses to report medication administration errors is linked to fear of being blamed for the deterioration of the patients health (3.3 ± 1.7), fear of the doctors reaction to a medication administration error (2.6 ± 1.4), and repressive responses from hospital management to reported misconduct (2.9 ± 1.5).

CONCLUSION

Measures to reduce the likelihood of medication administration errors include building a non-punitive system for reporting adverse events and medication errors, introducing electronic prescription systems, promoting open communication within the team, involving clinical pharmacists in the pharmacotherapy process, and regular comprehensive training of nursing staff.

Determinants of COVID-19 vaccine hesitancy among health care workers in Amhara region referral hospitals, Northwest Ethiopia: a cross-sectional study

Vaccine hesitancy remains a serious global threat to achieve herd immunity, and this study aimed to assess the magnitude and associated factors of coronavirus disease-19 (COVID-19) vaccine hesitancy among healthcare workers (HCWs) in Amhara regional referral hospitals. A web-based anonymised survey was conducted among 440 HCWs in the Amhara region referral hospitals. The questionnaire was designed using Google Forms and distributed using telegram and e-mail from 15 May to 10 June 2021 to the randomly selected participants in each hospital. The data were analysed with Stata 14.0 and described using frequency tables. A multivariable binary logistic regression model was fitted and model fitness was checked with the Hosmer-Lemeshow goodness of fit test. Out of 440 participants, 418 were willing to participate in the study and the mean age was about 30 years. Overall, 45.9% (n = 192) of participants reported vaccine hesitancy. After applying multivariate analysis, age ≤25 years (adjusted odds ratio (aOR) = 5.6); do not wear a mask (aOR = 2.4); not compliance with physical distancing (aOR = 3.6); unclear information by public health authorities (aOR = 2.5); low risk of getting COVID-19 infection (aOR = 2.8); and not sure about the tolerability of the vaccine (aOR = 3.76) were associated with COVID-19 vaccine hesitancy. A considerable proportion of HCWs were hesitant towards COVID-19 vaccine, and this can be tackled with the provision of clear information about the vaccine.

Medication Administration Error Reporting and Associated Factors among Nurses Working in Public Hospitals, Ethiopia: A Cross-Sectional Study

Background

Medication administration error is one of the most common errors that occur when a discrepancy occurs between the drugs received by the patient and the drug intended by the prescriber. A lot of studies were conducted on medication administration error. But there were a few studies on whether those medication administration errors are reported or not among nurses in Ethiopia. So this study is aimed at assessing the magnitude of medication administration error reporting and the associated factors among nurses.

Objectives

To assess the magnitude of reported medication administration error and associated factors among nurses working in public hospitals, Ethiopia.

Methods

An institutional-based cross-sectional study design was employed from March to April 2019. Simple random sampling technique was used. A structured self-administered questionnaire was used to collect the data. Data were entered using EpiData version 3.1 and descriptive analysis, bivariate, and multivariate logistic regression analyses were carried out using SPSS version 21 software.

Results

The magnitude of medication administration error reporting was found to be 37.9%. Being female [adjusted odds ratio (AOR) = 2.91; confidence interval (CI) (1.45-5.85)]; belief that errors should not be reported [AOR = .3; CI (.15-.61)]; having work experience of greater than 15 years [AOR = 3.4; CI (1.11-13.85)]; having bachelor science degree [AOR = 3.27; CI (1.61-6.66)]; and caring for greater than 10 patients [(AOR = .4; CI (.16-.96)] were factors associated with nurses medication administration error reporting.

Conclusion

The magnitude of medication administration error reporting among nurses was found to be low. To increase medication administration error reporting, efforts should be made to change the attitude of nurses on the belief that errors should be reported, retaining staffs that have longer experience, upgrading staffs educational status, and limiting the number of patients cared by a single nurse.